Journal article
Administration of Direct Oral Anticoagulants Through Enteral Feeding Tubes
The Journal of pharmacy technology, Vol.32(5), pp.196-200
10/2016
DOI: 10.1177/8755122516646384
PMCID: PMC5998521
Abstract
Objective:
To review literature regarding direct oral anticoagulants
(DOACs) and determine their viability of administration in solution or via
enteral tubes.
Data Sources:
MEDLINE literature searches identified
articles published 2007-present using MeSH terms: factor Xa inhibitors,
antithrombins, biological availability, and enteral nutrition. Package inserts
were included. Manufacturers were asked to provide literature.
Study
Selection and Data Extraction:
We included studies emphasizing
bioavailability or enteral administration.
Data Synthesis:
Dabigatran and edoxaban package inserts recommend against altering the dosage
form, and against enteral administration. One rivaroxaban study was identified.
Given with food, enteral administration was comparable to the oral tablet. The
mean AUC (0.889, 90% CI 86.12-91.84%) was within the equivalency margins;
however Cmax (0.820, 90% CI 78.84-85.86%) was slightly below the 80% threshold.
One apixaban study was identified. They showed bioequivalence between oral and
enteral administration in different vehicles, but decreased bioavailability when
crushed tablets were given along with nutritional support. AUC and Cmax were 32%
and 19% lower, respectively, when apixaban solution was given via nasogastric
(NG) tube with nutritional supplement versus oral administration of solution.
Conclusions:
Dabigatran capsules should not be altered, due to
large variations in drug exposure. Rivaroxaban can be given as oral solution or
via NG tube. Larger doses must be given with nutritional supplementation and
enteral tubes must not be distal to the stomach. Apixaban can be given as oral
solution or via nasogastric or gastric tube on an empty stomach. Food impairs
bioavailability of the crushed tablets. There are insufficient data to recommend
enteral administration of edoxaban and the package insert recommends against
altering tablets.
Details
- Title: Subtitle
- Administration of Direct Oral Anticoagulants Through Enteral Feeding Tubes
- Creators
- Jacob J Peterson - University of Iowa College of Pharmacy, Iowa City, IA, USAJames D Hoehns - University of Iowa College of Pharmacy, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- The Journal of pharmacy technology, Vol.32(5), pp.196-200
- DOI
- 10.1177/8755122516646384
- PMCID
- PMC5998521
- ISSN
- 8755-1225
- eISSN
- 1549-4810
- Publisher
- SAGE Publications; Sage CA: Los Angeles, CA
- Language
- English
- Date published
- 10/2016
- Academic Unit
- Pharmacy Practice and Science
- Record Identifier
- 9984065697302771
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